Scleral Cap Augmentation in Ocular Evisceration

To describe an anterior scleral capping technique using human donor sclera or preserved pericardium during ocular evisceration to enable the placement of larger orbital implants.

Retrospective interventional case series. Six consecutive patients underwent evisceration for blind, painful eyes without infection or suspected intraocular malignancy. Following standard evisceration, the largest possible spherical implant was inserted. A human donor scleral button (5 cases) or preserved pericardium (1 case) was sutured to the anterior scleral surface as a cap over the implant. Main outcome measures were graft integrity, implant size, successful prosthesis fitting, and postoperative complications.

Six patients (mean age 67 years) were included. The mean implant size was 18 mm. Five patients underwent scleral capping, and 1 received a pericardial graft. Five of 6 patients had an uncomplicated postoperative course, with intact grafts and successful prosthesis fitting. One patient developed partial graft dehiscence requiring implant exchange with a smaller implant. No implant exposures were observed over a mean follow-up of 12 months.

Anterior scleral capping during evisceration is a simple technique that allows for the placement of larger orbital implants without additional scleral incisions. Early results demonstrate good graft integration and favorable short-term outcomes. Larger studies with longer follow-up are needed to evaluate long-term safety and potential impact on post-enucleation socket syndrome.